A novel method of biopsy for indeterminate pancreaticobiliary strictures: tube-assisted biopsy

Abstract

Background Single-operator cholangioscopy (SOC) provides an accurate diagnosis of indeterminate pancreaticobiliary strictures. However, the procedure is expensive and can be performed using only limited accessories. Therefore, we devised a novel tube-assisted biopsy (TAB) technique and evaluated its feasibility, diagnostic yield, and safety for indeterminate pancreaticobiliary strictures. Methods The medical records of patients with indeterminate pancreaticobiliary strictures who underwent TAB between September 2018 and July 2019 were reviewed. We assessed the technical success rate, adverse event rate, sensitivity, specificity, and overall accuracy of TAB in differentiating malignant from benign lesions. Results TABs were performed in 16 patients: 12 had biliary strictures; four had pancreatic strictures. The technical success rate was 93.7 % (15/16), and the sensitivity, specificity, and overall accuracy of TAB were 87.5 %, 100 %, and 93.7 %, respectively. No serious adverse events occurred either during or after the procedure in any of the patients. Conclusions TAB has an acceptable accuracy for the diagnosis of indeterminate pancreaticobiliary strictures and may represent a useful diagnostic method in patients where SOC cannot be implemented.

Clinical impact of a novel device delivery system in the diagnosis of bile duct lesions: A single‐center experience

“…Pathological evaluation is important in diagnosing biliary tract diseases and selecting the appropriate treatments; however, it is currently associated with various challenges. [4][5][6]9,10 In this study, we introduced a novel device delivery system for bile duct biopsy that we developed and described its utility in the histological evaluation of biliary tract diseases.…”

“…Additionally, repeated transpapillary insertion of biopsy forceps can induce post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) 6–8 . Therefore, new devices and various approaches have been introduced; none of which have been satisfactory 9–12 . Recently, an assessment of biliary tract lesions under direct visualization using a cholangioscope has been reported to be a useful approach 13 ; however, this approach also has several challenges, such as the burden to the duodenal papilla, difficulties in delivering the cholangioscope through the biliary strictures caused by the carcinoma and in selecting the peripheral bile duct, and low sensitivity owing to insufficient specimens by using small dedicated forceps 14–16 …”

“…[6][7][8] Therefore, new devices and various approaches have been introduced; none of which have been satisfactory. [9][10][11][12] Recently, an assessment of biliary tract lesions under direct visualization using a cholangioscope has been reported to be a useful approach 13 ; however, this approach also has several challenges, such as the burden to the duodenal papilla, difficulties in delivering the cholangioscope through the biliary strictures caused by the carcinoma and in selecting the peripheral bile duct, and low sensitivity owing to insufficient specimens by using small dedicated forceps. [14][15][16] To address these issues, in our previous study, we focused on a biliary stent delivery system and reported its usefulness in pathological evaluation, namely, tumor biopsy and mapping biopsy, of perihilar CC.…”

Self-expandable metallic stent placement for malignant biliary stricture using a novel device delivery system

“…Several techniques for delivering devices into the bile duct have been described; however, these methods have operability, reliability, and safety issues. 1 , 2 , 3 , 4 We previously reported the effectiveness of a biliary stent delivery system for evaluating the superficial longitudinal extension of perihilar cholangiocarcinoma. 5 This system was originally developed for placing a plastic stent in the biliary duct, and it is composed of a guide catheter and pusher tube.…”

Tips and tricks for the diagnosis and management of biliary stenosis-state of the art review

“…The tube is then placed as close as possible to the stricture area and the guidewire removed. Conventional endobiliary biopsy forceps are inserted through the tube into the area of the stricture for tissue collection[ 28 ].…”